磁吻合技术治疗先天性食管闭锁与狭窄的临床疗效

Clinical efficacy of magnetic compression anastomosis for congenital esophageal atresia and stenosis

目的探讨磁吻合技术治疗先天性食管闭锁与狭窄的临床疗效。方法采用回顾性描述性研究方法。收集2017年12月至2019年2月西北妇女儿童医院收治的4例采用磁吻合技术治疗先天性食管闭锁与狭窄患儿的临床资料;男2例,女2例。4例患儿年龄分别为11 d、7 d、5 d、3岁。患儿均施行磁吻合技术食管吻合术。观察指标:(1)手术及术后情况。(2)随访情况。采用门诊和电话方式进行随访,了解患儿术后进食和并发症情况。随访时间截至2019年5月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示。结果(1)手术及术后情况:4例患儿均成功施行磁吻合技术食管吻合术。4例患儿中,3例食管闭锁行开胸气管-食管瘘修补术+内镜辅助磁吻合技术食管吻合术,1例先天性食管狭窄行消化道内镜+胃造瘘磁吻合技术食管狭窄疏通术。4例患儿手术时间为(2.3±0.9)h。3例食管闭锁患儿食管盲端距离为30~35 mm,1例先天性食管狭窄患儿食管狭窄段距离为8 mm。4例患儿术后磁环对位情况良好;术后磁环取出时间为(29±10)d;3例食管闭锁患儿经口取出磁环,1例先天性食管狭窄患儿经胃造瘘口取出磁环。4例患儿中,1例术后出现吻合口瘘、吻合口狭窄,经通畅引流、营养支持治疗后痊愈。4例患儿术后住院时间为(39±10)d。(2)随访情况:4例患儿均获得术后随访,随访时间为3~17个月,中位随访时间为10个月。术后第14~36天磁环脱落后经口或胃造瘘口取出磁环后经口进食。1例患儿术后3个月食管造影检查示吻合口狭窄行食管扩张后好转,其余3例患儿术后食管恢复连续性并保持通畅。4例患儿进食情况正常,未出现吞咽困难及其他严重并发症。结论磁吻合技术治疗先天性食管闭锁与狭窄安全、可行,近期疗效较好。

Objective To investigate the clinical efficacy of magnetic compression anastomosis for congenital esophageal atresia and stenosis. Methods The retrospective and descriptive study was conducted. The clinical data of 4 children who underwent magnetic compression anastomosis for congenital esophageal atresia and stenosis in the Northwest Women and Children′s Hospital from December 2017 and February 2019 were collected. There were 2 males and 2 females. The children were aged 11 days, 7 days, 5 days, and 3 years, respectively. The children underwent magnetic compression anastomosis. Observation indicators:(1) surgical and postoperative situations;(2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect food intake and complications of children up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Results (1) Surgical and postoperative situations: four children underwent magnetic compression anastomosis successfully. Of the 4 children, 3 with esophageal atresia underwent open tracheoesophageal fistula repair and endoscope-assisted magnetic compression anastomosis, and 1 with congenital esophageal stenosis underwent endoscopic gastrostomy combined with magnetic compression anastomosis. The operation time of 4 children was (2.3±0.9)hours. The length of esophageal blind ending in the 3 children with esophageal atresia and length of esophageal stenosis were in the children with esophageal stenosis 30-35 mm and 8 mm. Four children has good magnet apposition, and time of postoperative magnet removal was (29±10)days. Three children with esophageal atresia had oral removal of magnet, and 1 with esophageal stenosis had magnet removed by gastrostomy. One child complicated with postoperative fistula and anastomotic stenosis was cured by unobstructed drainage and nutritional support treatment. The duration of postoperative hospital stay was (39±10)days.(2) Follow-up: 4 patients were followed up for 3-17 months, with a median time of 10 months, and restored to oral intake after oral removal of magnet and removal of magnet by gastrostomy on the days 14-36 postoperatively. One child was detected anastomotic stenosis by esophagography at the postoperative 3 months, and was improved after esophageal dilatation. The other 3 children recovered to normal connectivity of esophagus postoperatively and maintain unobstructed. Four children had normal eating, without dysphagia or other serious complications. Conclusion Magnetic compression anastomosis is safe and feasible for congenital esophageal atresia and stenosis, with good short-term efficacy.